Signs of Appendicitis in Children Under 5: Study Review | Cincinnati Children's

Beth Rymeski, DO:
Hi, my name is Beth Rymeski. I’m a pediatric surgeon at Cincinnati Children’s. I want to talk to you today about a difficult patient population. Children under 5 who you suspect of having appendicitis. As we know, this can be an incredibly difficult diagnosis to make in small children. So, I wanted to review with you today three studies that have looked at the most common signs and symptoms to help you identify these patients and get them to early surgical evaluation.

The first study we’re going to talk about is a 28-year review of patients under age 3 that were seen at Sick Kids. Interestingly that only had about 1 patient per year. So not a very common diagnosis. However, they did find a few things. 100 percent of their patients under age 3 presented with a perforation and 67 percent of them presented with an X-Ray that was consistent with a bowel obstruction. And I think we see similar things here and that oftentimes an X-Ray would be done that suggests bowel obstruction, but really the underlying cause is appendicitis.

The second study looked at 63 patients under the age of 3. 57 percent of them were seen by a healthcare provider and initially misdiagnosed, and 84 percent were perforated at the time of the actual diagnosis. The most common presenting symptoms were over 80 percent with vomiting, more than 70 percent with pain, more than 60 percent with fever, and about 35 percent with diarrhea.

In terms of physical exam findings, the two most common findings present in over 60 percent of patients were diffuse abdominal tenderness and guarding.

The third and final study looked at 120 patients under age 5. Of the children under age 1, 100 percent presented perforated. This decreased as the child’s age increased however the best number was 69 percent perforated at age 5 which is still high perforation rate.

The most common symptoms they noted were pain in over 90 percent of patients, vomiting in over 80 percent, anorexia in about 70 percent, and again similar to the prior study, diarrhea in 35 percent of patients.

So, the takeaway really for this video is to maintain a high degree of suspicion in patients who are presenting to your office with any of these symptoms. We know this is a very rare diagnosis based on the studies. However, if you’re seeing a patient with abdominal pain, diarrhea, nausea, fevers or an X-Ray that looks like a bowel obstruction, we really need to see that patient to evaluate them for appendicitis.

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